Clinical features and prognosis of severe chronic active liver disease (CALD) after corticosteroid-induced remission

Disappearance of symptoms, resolution of most biochemical abnormalities, and histologic improvement to mild chronic inflammation were accomplished in 69 of 123 patients (56%) with severe chronic active liver disease treated with corticosteroids for up to 6.5 yr. Remission of at least 6 mo duration was possible in 35 of the 69 (51%) after discontinuation of therapy while others relapsed promptly and required retreatment. The likelihood of sustained remission was not predicted by initial clinical or biochemical features, although patients developing cirrhosis during treatment invariably relapsed. Subsequent courses of treatment after relapse were equally effective in again inducing remission, but the probability of another relapse increased after each successive therapy and was 86% after three treatments. Six of twenty-two patients (27%) followed for at least 4 yr after initial remission had three or more relapses. Although patients who relapsed were more likely to develop cirrhosis, manifestations of portal hypertension and immediate survival were not affected by relapse. Complete disappearance of all manifestations of active disease was possible in 12 of the patients entering remission (17%), but only patients without cirrhosis consistently sustained this improvement. We conclude that relapse after cessation of therapy frequently follows corticosteroid-induced remission of severe CALD, especially if cirrhosis develops, but does not jeopardize response to subsequent treatments or alter early prognosis.